Lab Final

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The order is to infuse Gentamicin 100 mg in 100 mL of 0.9% Normal Saline over 30 minutes. Calculate drops per minute using microdrip (60gtt/mL) and macrodrip (10 gtt/mL).

(100ml x 60 gtt)/ 30= Microdrip: 200 drops per min (100ml x 10 gtt)/ 30= Macrodrip: 33 drops per min

A Nitroglycerin drip (100mg in 250 cc D5W) is infusing on your patient at 28 mL/hour on the infusion pump. How many mcg/min is your patient receiving?

(mg/28mL)= (100mg/250mL) 2800/250=11.2 mg 11.2/60= 0.186 mg

Order: Dopamine 400 mg/250 cc D5W to start at 5 mcg/kg/min.Patient's weight is 190 lbs. Calculate mL/hr for order.

(order x volume x pt weight x mins)/ bag concentration

chest tube drainage system

*returns negative pressure to the intrapleural space *used to remove abnormal accumulations of air and fluid from the pleural space

12.5 mg IV q4-6hr PRN. Available: 50mg/mL. How many mL will you draw up to administer the ordered dose?

0.25 ml

3.5 mg IV q3-4hr; not to exceed 10 mg/dose or 40 mg/day. Available: 5mg/mL How many mL will draw up to administer the ordered dose?

0.7 ml

What is the normal electrical conduction pattern in the heart?

1)Sinoatrial node (SA) 2) Atrioventricular node (AV) 3) Bundle of His 4) Left and right bundle branches 5)Purkinje fibers.

Order: Fentanyl 5 mg/hr. The bag is labeled 250 mg in 500 ml of solution. How fast will the IV need to be infused to give the correct dose?

10 ml per hour

Morphine sulfate 4mg IV q 4 hours prn pain > 5. Patient has received a dose at 0900, 1330, and 1800. PCP calls and asks how much pain medication has the patient received in the last 12 hours?

12mg

A child with hives is prescribed diphenhydramine (Benadryl) 5mg/kg/day in divided doses every 6 hours. The child weighs 80lb. 36 kg What is the total daily dose? How many milligrams should the nurse give for each dose?

180mg 45mg

John Smith weighs 80 kg and is due for coronary bypass surgery. He has been ordered 250 mg of Dobutamine to be diluted in 50 mL of 0.9% Saline. If 5 mcg/kg/min is ordered how many mL/hr should be administered?

250 mg= 250,000 mcg/50 ml ( 5mcg x 50ml x 80kg x 60 min)/ 250,000mcg = 4.8 mL/hr

Order: Methylprednisolone 150mg IV q 12 hours. How many mL will you need to draw up to administer the ordered dose?

500mg/8mL 62.5mg/ml 150mg/62.5mg= 2.4 mL

What is a renal diet?

A diet to minimize the efforts on the kidneys while on dialysis, low sodium/phosphorus/protein along with fluid restrictions

Define the following blood products

A. Platelets: mall fragments of very large cells called megakaryocytes to help your body form clots to stop bleeding 100-700 ml don't have the Rh factor so not worry of reaction B. FFP: a blood product made from the liquid portion of whole blood to prevent bleeding C. Whole blood: red blood cells, white blood cells, and platelets suspended in plasma for patients who need all the components of blood, 25-50 ml D. PRBCs: Packed red blood cells to improve blood oxygen-carrying capacity and restore blood volume 300 ml E. Cryoprecipitate: highly concentrated source of fibrinogen from plasma product to control bleeding in people whose own blood does not clot properly

Describe

A. Temporary Colostomy: a hole is cut in the side of the colon and stitched to a corresponding hole in the abdominal wall that can be later reversed B. Permanent Colostomy: permanent exit for stool and will not be closed in the future C. Sigmoid or descending colostomy: made from the sigmoid and descending portion of the colon D. Transverse colostomy: made from the transverse section of the colon E. Loop colostomy: used in the middle section of the colon rather than an end or turning point F. Ascending colostomy: mae from the ascending portion of the colon G. Ileostomy: an opening in the abdominal wall that's made during surgery to excrete urine

List four kinds of blood reactions including signs and symptoms.

Allergic reaction: fever, chills, itching, hives Acute hemolytic reactions: dyspnea, fever, flushing, hypotension, tachycardia (blood is incompatible) Febrile nonhemolytic: fever, immunologic reaction, can still continue to have it Circulatory overload: renal, child/elderly, heart failure, COPD, assess fluid overload before administering Bacterial: could lead to sepsis Anaphylaxis: closing airway to death fast, immediate rxn (HTN, fever, itchy, tachycardia, drop O2 stats) Transfusion-related acute lung injury (TRALI): dyspnea, hypotension, and fever Delayed hemolytic reactions: fever, mild jaundice, and decline in hemoglobin concentration. Acute within the hour (allergic, hemolytic), can be delayed up to a week Check vitals before 15 mins after then continually check, bands are good for 72 hrs Rxn then discontinue then use new tube to pump fluids, contact the doctor, give oxygen Lower gauge is a risk for hemolysis (all the cells are broken)

What is angina? Myocardial infarction? How do we treat these conditions?

Angina: pain in the chest from inadequate blood supply to the heart Myocardial infarction: MI, lack of blood supply to the heart muscle

Cefazolin (Ancef)

Anti-infectives for bactericidal action against susceptible bacteria. Binds to bacterial cell wall membrane, causing cell death Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. diarrhea, nausea, vomiting, cramps, pain at IM site, phlebitis at IV site, rash, seizures IM: rapid, 0.5-2 hr, 6-12 hr IV: rapid, 5 min, 6-12 hr Risk for infection, diarrhea

Ceftriaxone

Anti-infectives for bactericidal action against susceptible bacteria. Binds to the bacterial cell wall membrane, causing cell death. Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins IM: rapid, 1-2 hr, 12-24 hr IV: rapid, end of infusion, 12-24 hr bleeding, eosinophilia, hemolytic anemia, leukopenia, thrombocytosis, pain at IM site, phlebitis at IV site, acute renal failure, diaherra Risk for infection, diaherra

Vancomycin

Anti-infectives for bactericidal action against susceptible organisms. Binds to bacterial cell walls, resulting in cell death. Renal impairment, intestinal obstruction or inflammation IV: rapid, end of infusion, 12-24 hr nephrotoxicity, eosinophilia, leukopenia, phlebitis, chills, fever, "red man" syndrome Risk for infection, risk for renal impairment

Atenolol

Antianginals to decreased BP and heart rate, decreased frequency of attacks of angina pectoris, prevention of MI. Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-receptor sites PO:1 hr, 2-4 hr, 24 hr Uncompensated HF, Pulmonary edema, Cardiogenic shock, Bradycardia or heart block. BRADYCARDIA, HF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction, erectile dysfunction, ↓ libido, urinary frequency, fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares Decreased cardiac output

Digoxin

Antiarrhythmics increase the force of myocardial contraction, prolongs refractory period of the AV node, decreases conduction through the SA and AV nodes. Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect) PO: 30-120 min, 2-8 hr, 2-4 days, IM: 30 min, 4-6 hr, 2-4 days, IV: 5-30 min, 1-4 hr, 2-4 days Uncontrolled ventricular arrhythmias, AV block (in absence of pacemaker), Idiopathic hypertrophic subaortic stenosis, Constrictive pericarditis, Known alcohol intolerance ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block, blurred vision, yellow or green vision, anorexia, nausea, vomiting, diarrhea, thrombocytopenia, electrolyte imbalances with acute digoxin toxicity, fatigue, headache, weakness Decreased cardiac output

Scopolamine

Antibiotics for reduction of postoperative nausea and vomiting, reduction of spasms Prevention of motion sickness, prevention of postoperative nausea and vomiting Inhibits the muscarinic activity of acetylcholine, corrects the imbalance of acetylcholine and norepinephrine in the CNS, which may be responsible for motion sickness. Transdermal: 4 hr, unknown, 72 hr Hypersensitivity, Angle-closure glaucoma, Acute hemorrhage, Tachycardia secondary to cardiac insufficiency or thyrotoxicosis. tachycardia, palpitations, blurred vision, mydriasis, photophobia, dry mouth, constipation, urinary hesitancy, urinary retention, drowsiness, confusion Risk for injury

What are five nursing diagnoses that would be appropriate for your cancer patient?

Anticipatory grieving, acute pain, fatigue, risk for infection, fear/anxiety

Warfarin (Coumadin)

Anticoagulants for prophylaxis and treatment of DVT/PE, management of MI, prevention of thrombus formation and embolization after prosthetic valve placement. Prevention of thromboembolic events, interferes with hepatic synthesis of vitamin K-dependent clotting factors (II, VII, IX, and X). PO: 36-72 hr, 5-7 days, 2-5 days Uncontrolled bleeding, Open wounds, Active ulcer disease, Recent brain, eye, or spinal cord injury or surgery, Severe liver or kidney disease, Uncontrolled hypertension dermal necrosis, cramps, nausea, CALCIPHYLAXIS, BLEEDING, fever Risk for bleeding

Diphenoxylate/atropine (Lomotil)

Antidiarrheals to decreased GI motility with subsequent decrease in diarrhea Adjunctive therapy in the treatment of diarrhea Inhibits excess GI motility, structurally related to opioid analgesics but has no analgesic properties, atropine added to discourage abuse Difenoxin-PO: 45-60 min, 2 hr, 3-4 hr Diphenoxylate-PO: 45-60 min, 2 hr, 3-4 hr Severe liver disease, Infectious diarrhea (due to Escherichia coli, Salmonella, or Shigella), CDAD, Dehydrated patients, Angle-closure glaucoma, Known alcohol intolerance dizzine, ss, confusion, drowsiness, headache, insomnia, nervousness, constipation, dry mouth, epigastric distress, ileus, nausea, vomiting Constipation

Ondansetron (Zofran)

Antiemetics to decrease incidence and severity of nausea and vomiting following chemotherapy, radiation, or surgery Blocks the effects of serotonin at 5-HT3 receptor sites (selective antagonist) located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS PO, IV: rapid, 15-30 min, 4-8 hr IM: rapid, 40 min, unknown Orally disintegrating tablets contain aspartame and should not be used in patients with phenylketonuria, congenital long QT syndrome, concurrent use of apomorphine. TORSADES DE POINTES, QT interval prolongation, constipation, diarrhea, abdominal pain, dry mouth, ↑ liver enzymes, extrapyramidal reactions, SEROTONIN SYNDROME, headache, dizziness, drowsiness, fatigue, weakness, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS Impaired mucus lining

Metoclopramide

Antiemetics to decrease nausea and vomiting, decreased symptoms of gastric stasis, easier passage of nasogastric tube into small bowel Blocks dopamine receptors in chemoreceptor trigger zone of the CNS, stimulates motility of the upper GI tract and accelerates gastric emptying PO: 30-60 min, unknown, 1-2 hr, IM: 10-15 min, unknown, 1-2 hr IV: 1-3 min, immediate, 1-2 hr Seizure disorders, hypertension, pheochromocytoma, history of tardive dyskinesia, parkinson's disease drowsiness, dysgeusia (intranasal), extrapyramidal reactions, restlessness, neuroleptic malignant syndrome, anxiety, bradykinesia, cog-wheel rigidity, depression, irritability, tardive dyskinesia, tremor Altered nutrition

Rituximab (Rituxan)

Antineoplastics to cause death of lymphoma cells, prolonged progression-free survival in CLL, reduced signs and symptoms of rheumatoid arthritis, achievement of complete remission in GPA, MPA, and pemphigus vulgaris IV:within 14 days, 3-4 wk, 6-9 mo Hypersensitivity to murine (mouse) proteins, OB: Can pass placental barrier potentially causing fetal B-cell depletion, lactation Arrhythmias hypotension, peripheral edema, STEVENS-JOHNSON SYNDROME (SJS), flushing, urticaria, hyperglycemia, hypocalcemia, HEPATITIS B REACTIVATION, abdominal pain, altered taste, dyspepsia, renal failure, ANEMIA, NEUTROPENIA, THROMBOCYTOPENIA, arthralgia, back pain, PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, headache, bronchospasm, cough, dyspnea, TUMOR LYSIS SYNDROME, fever/chills/rigors (infusion related), infection

Omeprazole (Prilosec)

Antiulcer to diminished accumulation of acid in the gastric lumen with lessened gastroesophageal reflux, healing of duodenal ulcers. GERD/maintenance of healing in erosive esophagitis, duodenal ulcers (with or without anti-infectives for Helicobacter pylori), short-term treatment of active benign gastric ulcer, reduction of risk of GI bleeding in critically ill patients. Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. PO-delayed release: within 1 hr, within 2 hr, 72-96 hr Hypersensitivity to omeprazole or related drugs (benzimidazoles), concurrent use of rilpivirine. CLOSTRIDIUM DIFFICILE-ASSOCIATED DIARRHEA (CDAD), abdominal pain, acid regurgitation, constipation, diarrhea, flatulence, fundic gland polyps, nausea, vomiting Altered nutrition

Identify where you listen for heart sounds and the valve you are listening to at each spot.

Aortic valve Pulmonic valve Mitral valve Tricuspid Apex

What should be documented when caring for a patient with a chest tube?

Assess respiratory status, vitals, amount of suction and drainage, pain

How is the NG's placement verified?

Attach an empty syringe to the NG tube and gently flush with air to clear the tube. Then pull back on the plunger to withdraw stomach contents then empty the stomach contents onto all three squares on the pH testing paper and compare the colors with the label on the container. Xray

Barium swallow, biopsy, FISH

Barium swallow: x-ray imaging of mouth, back of the throat, esophagus, stomach, and first part of your small intestine Biopsy: removing tissue or cells from the body to be reviewed by a pathology FISH: Fluorescence in situ hybridization, visualize specific genes or portions of genes to determine abnormalities

What are calcium channel blockers?

Blocks the calcium channels to lower blood pressure. Amlodipine/Diltiazem

What are beta blockers?

Blocks the effects of epinephrine to slow the heart. Metoprolol/Atenolol

List the equipment needed for a blood transfusion.

Blood bag, Saline drip, new tube, alcohol wipe

What are the four types of radiation therapies?

Brachytherapy, external beam radiation, stereotactic body radiotherapy, proton therapy

CK, CPK-MB & Troponin, What is the purpose of these tests? What are the adult normal values?

CK: monitor muscular injuries and diseases, 22 to 198 U/L CPK-MB: diagnosis of an acute myocardial infarction, 26 - 192 U/L Troponin: measures the levels of troponin T or troponin I proteins released when the heart muscle has been damaged, 0-0.04 ng/mL

Identify four antineoplastic therapies?

Chemotherapy, immunologic, targeted agents, hormonal agents

What is CBI?

Continuous bladder irrigation

How do you count the heart rate on a cardiac rhythm strip?

Counting the larger boxes then multiplying by 10

Assessment before dialysis?

Daily weights, edema, fluid status, temperature, BP, feel turbulent blood come (thrill), hear flowing sound (bruit) hear or feel nothing means losing access, bleeding,

Name three nursing diagnoses that would be applicable for a patient with an ostomy.

Disturbed Body Image, Impaired Skin Integrity, Acute Pain

What equipment should be kept at bedside while patient has a chest tube in place?

Drainage tubing, sterile water, emergency equipment, suctioning

How do we educate our patients/families with altered nutrition/less than body requirements to prevent possible skin breakdown?

Eat smaller high nutrition density meals more frequently, if eating less find different forms to obtain nutrients such as shakes

Explain how and when you would flush an NG.

End of a cycled feeding or after giving medicine through the tube.

Name three nursing diagnosis that a person with renal failure may have?

Excess fluid volume, deficit fluid volume, imparied electrolyte balance

Explain nursing care of a patient with a chest tube.

Feeling for crepitus, a result of air or gas collecting under the skin (subcutaneous emphysema), assess drainage tubing to ensure that there are no dependent loops or kink, fluid level in the suction chamber

What kind of access ports are used for dialysis?

Fistula (creates a high pressure system for the vein), CVA, or graft

Describe the process of administering a blood transfusion.

Flush the IV for patency, make sure all the information matches, spike the blood and saline and slowly infuse

What is tachycardia? Bradycardia?

HR greater than 100 HR lesser than 60

Helicobacter pylori, occult blood, amylase and albumin. What is the purpose of these tests? How do you collect these tests? What is normal?

Helicobacter pylori: stool test to identify the presence of H pylori and antibiotics used to treat it, ≤30 U/mL Occult blood: check stool samples for hidden blood that may indicate colon cancer or polyps in the colon or rectum, normal is less than 2 to 3 mg/gm Amylase: measures the amount of amylase in blood or urine, may indicate a pancreas disorder or other health condition, 40-140 U/L Albumin: measures the amount of this protein of the blood, may indicate dehydration or severe diarrhea, 3.4 to 5.4 g/dL

What are the different types of dialysis?

Hemodialysis: dialyzes machine used to clean the blood through vein entrance Peritoneal dialysis: access the peritoneum to filter the blood

List some conditions that may require blood therapy.

Hemorrhage, cancer, hemophilia, Von Willebrand disease

What is Rh factor?

Inherited protein found on the surface of red blood cells

What is a cardiac glycoside?

Inhibit the Na+ K+ ATPase enzyme. Digoxin/Digitoxin

What are statins?

Inhibits HMG-CoA reductase. Atorvastatin/Lovastatin

How does the RN assess the GI system

Inspection, auscultation bowel sounds, palpation of the abdomen to identify visible abnormalities, percussion, assess health hx

What is anemia?

Lack of healthy RBC cells

What are anti-hypertensives?

Lowers blood pressure. Lisinopril/Furosemide

What education will you need to provide to your patient receiving chemotherapy?

Maintain proper hygiene practices to reduce infection, chemo kills rapid dividing cells so in addition to the cancer cells the medicine will attack hair cells and neutrophils

What are the differences between modifiable vs non-modifiable risk factors for cancer?

Modifiable: risk factors that are within an individual's control (smoking, environmental exposure, diet) Non-modifiable: risk factors that are out of an individual's control (age, gender, genetics)

What items are needed for placement of a NG tube?

NG tubing, water-soluble lubricant, cloth tape, tegaderm, 10 milliliter syringe, pH paper.

What is a dob-hoff?

Narrow-bore flexible tube with a diameter of 4 mm, used to deliver enteral nutrition

What are three oncology emergencies?

Neutropenic fever, tumor lysis syndrome, hyperkalemia

What type of blood is the universal donor?

O-

What are the measurements for: PR interval QRS complex QT interval

PR interval: beginning of the P wave between the beginning of the QRS complex QRS complex: beginning of the Q wave to the end of the S wave QT interval: beginning of the Q wave to the end of the T wave

What should be documented when caring for someone receiving CBI?

Pain, date, time, assessment of fluid, patient's response, amount and characteristics of irrigation

What are potential complications when a patient has a chest tube?

Pain, vascular injury, improper positioning of the tube, empyema, pneumonia

What are the nursing precautions when caring for someone receiving radiation therapy?

Placing the patient in their own room, personalized items are left in the room for that patient, wear proper PPE, monitor skin condition

Pleural fluid analysis and Blood cultures? What information do these tests give us? How are they obtained?

Pleural fluid analysis: examines a sample of fluid collected in the pleural space to see infection or understand the cause of buildup of fluid in this space, a needle is placed through the skin and muscles of the chest wall into the pleural space Blood cultures: checks a sample of blood for bacteria that might be causing the infection, blood samples get mixed with cultures to examine the effect

What is a pneumothorax? Pleural effusion? Hemothorax? What are the signs and symptoms of each?

Pneumothorax: collapsed lung, sharp chest pain that worsens when trying to breath, SOB, cyanosis, rapid breathing, dry cough listening to the lung sounds absent at the apex Pleural effusion: buildup of fluid between the lung tissue linings, chest pain, dry cough, dyspnea, orthopnea listening to lung sounds absent at the bases Transudative: increases hydrostatic pressure or low plasma osmotic pressure, fluid in the space due to pressure changes, fluid that has low protein and LDH can be tested. CHF/cirrhosis/hypoalbuminemia/nephrotic syndrome Exudative: high in protein and lactate hydranse, infection/increased capillary permeability (pneumonia, viral infections, cancer, PE, autoimmune) Hemothorax: blood in the pleural cavity, SOB, rapid breathing, chest pain, low BP, pale, cool, clammy skin listening to lung sounds absent at the bases

What is an ostomy? Stoma?

Pouch system that provides a means for the collection of waste from a surgically diverted GI, opening in the patient's abdomen wall to excrete waste

Identify three purposes of a NG tube.

Provide nutrition, lavage, decompression

Label the ECG leads?

RA LA (right and left arm) RL LL (right and left leg) V1-V6 (4th intercostal to midaxillary line)

Describe aspiration precautions when your patient has an NG tube.

Raise the head of the bed to at least 30 degrees, make sure to replace every 24 hrs, flush with warm water to prevent obstructions

What questions do you ask to determine a heart rhythm?

Rate, feeling in the distal pulses, ECG readings, auscultating the heart

What foods should a patient with an ostomy avoid?

Raw fruits and vegetables, nuts and seeds

What does ST elevation mean? ST depression?

ST elevation/depression is the ischemia of the heart muscles

Droperidol (Inapsine)

Sedative for tranquilization, suppression of nausea and vomiting in selected situations. Used to produce tranquilization and as an adjunct to general and regional anesthesia Similar to haloperidol-alters the action of dopamine in the CNS IM, IV:3-10 min, 30 min, 2-4 hr Hypersensitivity, Known intolerance, Angle-closure glaucoma, Bone marrow depression, CNS depression, Severe liver or cardiac disease, Known or suspected QT prolongation. SEIZURES, extrapyramidal reactions, abnormal EEG, anxiety, confusion, dizziness, hypotension, tachycardia, ARRHYTHMIAS Ineffective breathing pattern

5. What does stenosis mean? Regurgitation?

Stenosis: mitral valve narrows which constricts blood flow to the ventricles Regurgitation: the valve doesn't completely shut allowing backflow into the atriums

Why is it important to know these cardiac arteries?

They supply the blood to the heart itself therefore if there is an obstruction it could result in an MI

What is the purpose of dialysis?

To provide adequate filtration of blood while the kidneys are unable to do so

List the primary purpose for blood therapy.

To supply blood/products that are not sufficient for the patient to sustain

What is TPN? What are some considerations you need to assess for when a patient is receiving TPN?

Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract, compare the patient's baseline vital signs; electrolyte, glucose, and triglyceride levels; weight; and fluid intake and output with treatment values

What are the time requirements for a transfusion of PRBC?

Transfused at a rate of 1 to 2 mL/min for the first 15 minutes and then increased to 4 mL/min or as rapidly as the patient can tolerate, should not exceed 4 hours.

Explain how you will ensure protecting your patient from central line infections.

Washing hands prior to touching the central line, wear proper PPE, create a sterile field around the central line, use chlorhexidine solution for disinfecting, remove them when they are no longer needed

What are the nursing precautions when caring for someone receiving chemotherapy?

Wearing appropriate PPE, administer antiemetic medication before receiving chemo

telemetry leads.

White: RA, right midclavicular line within the rib cage frame Green: RL, right lateral abdomen Brown: 4th intercostal right sternal border Black: LA, left midclavicular line within the rib cage frame Red: LL, lower left abdomen

How would you assess residuals when someone is receiving tube feedings?

Withdraw gastric fluid via the feeding tube by pulling back on the plunger of a large syringe at intervals typically ranging from four to eight hours

P Wave

atrial depolarization action potential immediately before contraction coming from the SA node

S wave

beginning of ventricular repolarization final depolarization of the ventricles at the base of the heart

R wave

first upward deflection after the P wave depolarization of the main mass of the ventricles

Q wave

net direction of early ventricular depolarization initial depolarization of the interventricular septum

Name equipment needed to care for a patient's ostomy.

ostomy bag and clip, scissors, stoma measuring guide, skin prep, stomahesive, gloves

Describe anatomically is a chest tube placed?

pleural:4th or 5th intercostal space in the mid- or anterior- axillary line pneumo: up to 2nd intercostal empyema needs larger diameter tube

QRS complex

ventral depolarization ventricles are contracting, artia is repolarizing getting ready for the next beat

T wave

ventricle repolarizing repolarization of the ventricles


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